Closing the Gap: The Rise of Teleconsultation, Virtual Wards, and Remote Monitoring in Perioperative Medicine

Megan Rolfzen, MD

An expert panel convened to discuss a shift towards intensive postoperative care, dubbed the “fourth branch” of anesthesia on Saturday morning at the 2026 Annual Meeting, presented by IARS and SOCCA, in Montreal. Moderated by Manoj Lalu, MD, PhD, FRCPC, an anesthesiologist and scientist at The Ottawa Hospital and an associate professor in the Department of Anesthesiology and Pain Medicine at the University of Ottawa, the session titled, “From Preop to Postop: Transforming Perioperative Care Through Virtual Innovation,” provided a comprehensive look at how digital tools are being utilized to bridge care gaps, improve patient safety, and streamline clinical workflows. From the initial preoperative anesthesia clinic visits to the first critical days after discharge, virtual innovation may redefine anesthesiologists’ role as stewards of patient recovery and safety outside of the operating room.

David MacDonald, MD, FRCPC, an anesthesiologist and medical director of perioperative medicine at Dalhousie University, opened the session by examining the evolution of virtual preoperative assessments. He noted that while telemedicine accounted for only 1.6% of physician visits in Canada before the COVID-19 pandemic, that rate has skyrocketed since. In TELANESTH, a randomized, controlled, single-blind, noninferiority study comparing teleconsultation with face-to-face consultation, there was no difference in cancellation rates or immediate perioperative complications. Importantly, virtual assessments afford significant savings in time, cost, and travel stress. Currently, the VIRTUAL study, led by Daniel I. McIsaac, MD, MPH, FRCPC, a senior scientist and anesthesiologist at The Ottawa Hospital, is investigating whether these digital pathways affect 90-day morbidity and mortality.

David Brealey, MD, a consultant in anaesthesia and intensive care medicine of University College London Hospitals addressed the fundamental weakness in current intra-hospital and ward-based care: the failure to adequately anticipate deterioration in vital signs. In many European healthcare systems, vital signs are only recorded one to four times a day. The concept of a “virtual ward” utilizing wearable technology is one solution. One example is Checkpoint Cardio’s CPC12S, a wearable device that accurately measures heart rate, respiratory rate, oxygen saturation, blood pressure, and temperature continuously. However, the application to high-acuity settings is still being validated. Dr. Brealey emphasized that embedding these tools into complex healthcare systems is difficult and requires more robust evidence to move beyond the current “hype.”

The final segment of the panel, led by Sylvie Aucoin, MD, MSc, FRCPC, an anesthesiologist at The Ottawa Hospital and associate professor in the Faculty of Medicine at the University of Ottawa, focused on Postoperative Virtual Care and Remote Monitoring (PVC-RAM). With earlier discharges becoming prominent, a critical care gap has emerged, as up to 50% of surgical complications in the United States now occur after the patient has been discharged. The PVC-RAM model utilizes daily surveys, wound photos, virtual nurse visits, and remote vital monitoring to extend the hospital’s reach into the home. Dr. Aucoin outlined procedure-specific care pathways, ranging from low-intensity three-day follow-ups for gynecology cases to high-intensity ten-day protocols for lobectomy or cystectomy patients sent home with monitoring kits. The patient experience has been overwhelmingly positive, with even those over 65 finding the technology easy to use and appreciating the immediate support. The success of these programs, she argued, depends on a “coalition of the willing,” including engaged surgeons, administrative support, and specialized education for virtual nurses.

The session concluded with a look at future directions, including integrating paramedics and home care into virtual pathways. As anesthesiologists’ role continues to evolve, these technological innovations offer a promising roadmap to ensure that the quality of care remains high, even after the patient leaves the operating room.